Sleep ethic

I was drinking my coffee unawares the other morning when I somehow got roped into a rather unpleasant exchange.

"I don't know if anyone's told you yet," said the blonde-haired senior resident who comes from money, "but your role in the NICU is to stay awake. Don't ever, ever go to sleep when you are on call. You need to be available to answer questions about the patients you're covering."

"That's bullshit," said the brown-haired senior resident with the eating disorder. "It's not like anyone ever comes to us with questions about our patients--they go straight to the nurse practitioners, who rarely have any interest in teaching us, anyway. And there really are long stretches of time when nothing happens. Sleep whenever you get the chance."

The blonde ignored her. "As an intern," she insisted, "staying awake is the least you can do." She indicated in her way that this was the end of the conversation, and I went back to drinking coffee. But I thought to myself, the least I can do? In what sense is being awake actually doing anything?

It's a pretty common thing for residents on call to stay awake in order to stay awake, with the endpoint of saying to their colleagues, "I stayed awake." I suspect they are confusing their sleep ethic with a work ethic, and responding to an institutional trend toward mistaking alertness for actually caring about anything, especially patients.

I bought into the ethic for about five minutes. The first night I was on call, I accidentally slept 4 hours, and felt terribly guilty the next day. I stayed awake the next call night, after which I decided I was being ridiculous. On my third call night, with absolutely nothing to do, I slept for four hours and woke up at 4:30 a.m. Before I left that morning, one of my sicker patients took a turn for the worse, and I stuck around for an extra hour past my work-hour limit to round on him with the team and explain his situation to his parents. I was aware at the time that I felt able to do this because I wasn't dead to the world--because I had slept when I could.

A few days later, my attending pulled me into his office. "Dr. Signout," he said, "I really appreciate your commitment to Baby Totally-Gonna-Die. When you stayed past work hours the other morning to help take care of him, it showed the kind of commitment to learning and patient care that we love but are not allowed to encourage any more."

I didn't tell him that it hadn't been that bad because I'd been pretty well-rested. I didn't want my having slept to somehow diminish what he saw as good patient care.

Of all the things to be secretive about doing at night, I never imagined sleeping would be one.